The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

Abstract

To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience. A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database. Nine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4.5%) and 34 severe (3.4%). Over-sewing of staple line was performed in 689 cases (76.2%), and no SLR in 217 cases (24.0%) without significant impact on mild or severe early morbidity. Bougie size 36 Fr or smaller was used in 635 cases (73.0%) without significant differences in early complications compared to 235 cases (27.0%) with larger bougie. LSG, as revision bariatric surgery, was performed in 273 cases (27.7%). Concomitant removal of a gastric band was performed in 199 of these cases (72.9%). History of silastic ring vertical gastroplasty (SRVG) was recorded in 10 cases (1.0%). Previous bariatric surgery was a significant risk factor for early mild complications (OR=1.14, p value=0.02), but not for severe ones (OR=0.79, p value=0.09). Concomitant removal of gastric band did not affect this result. The risk for mild complication was significantly reduced with surgeon experience achieving 100 cases. SLR or bougie size is not affecting LSG morbidity, but previous bariatric history and surgeon experience are significant factors for early mild complications.